International study shows UK GPs rate improvements to their health service highest

Andy Burnham welcomed the findings at a speech in Washington, and said it showed that the overhaul of the health service had paid off

UK health secretary Andy Burnham spoke about the challenges facing the NHS. He said targets were necessary but excessive reliance on them had become disempowering. Photograph: Christopher Thomond/Guardian

Thursday 5 November 2009 05.52 EST
First published on Thursday 5 November 2009 05.52 EST

GPs rate improvements to the quality of patient care in the UK more highly than doctors in 10 other industrialised countries rate their health services, according to an international comparative study released today.

Coincidentally, British primary care physicians also emerge as those most likely to be financially rewarded for meeting medical targets or care goals.

The study of health services in 11 nations, carried by the US-based Commonwealth Fund, was welcomed by the health secretary, Andy Burnham, who acknowledged to a Washington audience that excessive reliance on health targets had "become disempowering" for NHS front line staff.

Responding to the question of whether the quality of patient care had got better in their health service over the previous three years, 51% of British GPs said it had improved, 37% thought it had stayed the same and 12% rated it as becoming "worse".

Around a third of doctors in Italy and Netherlands reported improvements in their countries' health systems. In Germany, only 1% recorded improvements while 73% said the system had got worse.

On financial incentives for GPs, 89% of British doctors reported they received or had the potential to receive extra financial support. New Zealand was in next place with a figure of 80% overall, while at the bottom of the scale, only 10% of Swedish doctors reported such payments.

The study follows a report from the National Audit Office last year which showed GP partners who run practices had seen their pay increase 58% since 2002/03 to £113,614 in 2005/06. A report from the Commons public accounts committee concluded that the new contract made it too easy for doctors to earn high salaries through performance-related pay.

The UK also had the lowest proportion of doctors reporting long waiting times for patients to a see a consultant or medical specialist. The UK figure was only 22%, compared to 75% in Canada, 55% in Norway, 63% in Sweden and 28% in the USA.

In a speech to the Urban Institute in Washington, Burnham said radical challenges facing the NHS: "will mean spending less in hospitals and more closer to the patient's home. It will mean changes to services on a scale not seen before in its 61-year history, which will raise another difficult public debate.

On NHS targets, he insisted that they had fostered improvements. "Targets drove the system hard and were the right thing to do. But we have come to learn that the top-down approach can only take you so far.

"It is not a great way to win the hearts and minds of the people who must make it all work. Looking back, I can see now how the emphasis on targets began to imply a lack of trust in staff at the front line that become disempowering." It is the furthest he has gone in making such an admission.

He added: "For many in the Labour Movement, the NHS is sacred and changing it is hard-fought. But, because we did, and because it is now delivering for the public, it is our strongest card as a government as we head into the coming general election."

Without specifying what changes might be adopted, he explained: "We want to take the best of the US system make it available to everyone."

The Department of Health hailed the Commonwealth Fund study, claiming it showed the NHS had "one of the best primary health care systems in the world".

Responding to the its findings, Burnham said: "This is an important moment for the NHS. The journey to overhaul the quality of care over the last ten years has paid off. Clinicians now say they are confident they are treating and caring for patients in ways that match the best healthcare systems in the world. The NHS is not perfect but it has moved from poor to good and I want to see it go from good to great on the next stage of the journey.

"Primary care services are at the heart of the NHS, preventing illness, managing disease and helping people live healthier lives. Most recently our GPs have been doing a fantastic job at the forefront of our response to the swine flu outbreak starting the vaccination programme."

Yesterday the Conservative health spokesman Andrew Lansley claimed that "new analysis" of the latest OECD health data revealed that "the UK ranks in the worst quarter of European countries on deaths from breast cancer" and that "deaths from lung disease in the UK are 75% higher than the European average". The study, he added, also showed that: "You are more than twice as likely to die of a heart attack in the UK as in the best performing country in Europe - France."